Provider Demographics
NPI:1528160066
Name:WILSON, DARLENE (APRN)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41314-0038
Mailing Address - Country:US
Mailing Address - Phone:606-593-6400
Mailing Address - Fax:606-593-8114
Practice Address - Street 1:453 OLD KY 11
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41314-0038
Practice Address - Country:US
Practice Address - Phone:606-593-6400
Practice Address - Fax:606-593-8114
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YP2500X
KY3004956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYNP00111Medicare PIN